Guest Opinion: I have HIV and I am alive — thanks to San Francisco

  • by Michael J. Madrigal
  • Wednesday April 24, 2024
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The San Francisco AIDS Foundation contingent marched in the 2019 San Francisco Pride parade. Photo: Rick Gerharter
The San Francisco AIDS Foundation contingent marched in the 2019 San Francisco Pride parade. Photo: Rick Gerharter

I am 59 years old, have lived in our great city for nearly 40 years, and I have been HIV-positive for 30 of them. Against all odds, I am alive and doing reasonably well. Why? Because of our city's extraordinarily successful approach to addressing HIV/AIDS, known across the country as the "San Francisco Model."

Alarmingly, this unique crown jewel is threatened as Mayor London Breed and the Board of Supervisors grapple with a budget shortfall over the next two fiscal years. In deciding where to let the ax fall, they inevitably will feel pressured to make cuts based on political dynamics rather than on hard data. Instead, one principle should be paramount: protecting and strengthening social service programs that statistics show are actually working and working well.

San Francisco's response to HIV/AIDS, the San Francisco Model, is one of them. It began in the early 1980s when hundreds, and then thousands, of gay men here were dying of AIDS and organizations of all types and sizes sprung up to care for the needs of those with the disease — and to press the city, state, and federal governments to respond.

Even as the epidemic changed, this continuum of care approach has remained and improved over time, and I've been a beneficiary of that. Today, wraparound services are provided by a tight, non-competitive network of groups with expertise in specific areas related to HIV that include medical care, education, benefits eligibility, housing and eviction prevention, and legal services.

The results of the San Francisco Model are stunning. I've learned that in nearly every measurable way, San Francisco is doing better at addressing HIV than any other city in the nation. For example, even though our city has one of the highest percentages of residents living with HIV and one of the highest percentages of residents at risk for contracting it, the rate of new infections among LGBTQ residents here is dramatically lower than in other cities, including New York City; Washington, D.C.; Austin, Texas; Seattle, Washington; and Miami-Dade, Florida. One of the reasons is because our model has ensured that 75% of San Franciscans with HIV have suppressed their viral loads to the point where the virus cannot be transmitted, a much, much higher percentage than every other city in the country, other than Seattle. Similarly, more than nine in 10 of those recently diagnosed with HIV in San Francisco are connected to care. That's 12 percentage points higher than anywhere else.

Clearly, the San Francisco Model is working. I am a living testament to that. When I was within a few hours of dying because of HIV, an amazing team at UCSF saved me. When I was facing eviction from my apartment after my lover died of ALS and my name wasn't on the lease, lawyers at the AIDS Legal Referral Panel made sure that didn't happen. Time and again when I've faced complex challenges with health insurance and other critical benefits, case managers at PRC have been there for me. I could go on and on, but you get the point. I wouldn't be here without them.

While this model is indeed a crown jewel, the organizations delivering the services necessary to its success don't have palatial offices and almost all of their employees live on modest salaries. Believe me, I know they are all working on shoestring budgets and making every dollar count. That's why I and so many other HIV-positive San Franciscans are so concerned about where the budget ax is going to fall — there's simply no fat to cut. What might be perceived as a modest reduction in funding will, in fact, have devastating results: the city's ability to control the disease would be undermined, and the entire model that has been so effective would be significantly weakened.

Breed and gay Supervisors Rafael Mandelman (District 8) and Matt Dorsey (D6) have been champions in supporting the fight against HIV and sustaining our model of care. In 2022, for example, they led the creation of a major initiative that included securing $3 million in the budget to support community organizations providing HIV testing, prevention, and care services that were affected by a change in the allocation and distribution of HIV prevention funding by the San Francisco Department of Public Health, as the San Francisco AIDS Foundation noted at the time. That also helped to ensure that free HIV services provided to the community were not disrupted. The funding bolstered efforts to bring new HIV infections to zero by 2025, and included money to help HIV-positive residents from becoming homeless.

This year, we are counting on the mayor and our supporters on the Board of Supervisors to ensure hard budget decisions don't end up decimating what's been built up over the last four decades. We'll never get it back. Ever.

Michael J. Madrigal is a gay man living in San Francisco.

The San Francisco AIDS Foundation will be holding a city budget teach-in Monday, May 6, from 7 to 9 p.m. For more information, see the item in the News Briefs column.

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